Diabetes Flashcards
What is MODY?
Maturity-onset diabetes of the young (type 2 picture in a young person)
What is LADA?
At what age does it most commonly present?
Late + autoimmune diabetes of adulthood (autoimmune destruction of pancreas, but happens at a slower rate than in DM1)
Late 20s
What are RFs for gestational diabetes?
History in a previous pregnancy, FH, obesity, Afro-Caribbean , Asian, previous large baby or still birth (may have had gestational diabetes then)
What does gestational diabetes predispose women to?
DM2 in later life
What is the pathophysiology of DKA?
excessive glucose but a lack of insulin, so it can’t be taken into cells to metabolise. The body is pushed into a starvation-like state where ketoacidosis is the only mechanism of energy production
How may DKA present?
Ketotic (sweet-smelling) breath. Generalised abdo pain, N+V, hyperventilation, reduced consciousness, Kussmaul breathing
What is Kussmaul breathing?
Deep + laboured breathing
How is DKA diagnosed? (3 things)
- Diabetic: blood glucose >11
- Ketones: >3 or urinary >2
- Acidotic: pH <7.3 or bicarb <15
How is DKA managed?
IV insulin + dextrose
Fluids: 1 L 0.9% saline over 1 hour
What should be done in DKA if systolic BP is <90?
Bolus 500ml saline over 15 minutes, then give
What is HHS (Hyperosmotic Hyperglycaemic state)
3 parts
Hypovolaemic
Marked hyperglycaemia >30mmol/L
Osmolality >30
What is HHS usually precipitated by?
Another illness
How do you manage HHS?
Fluid resus (IV 0.9% saline over 1 hour) Aiming for a positive balance by 2-3 L over 6 hours
How many tests are needed to diagnose DM?
1 - if patient is symptomatic
2 - if asymptomatic (2 + results on 2 separate occasions)
What test is used for diagnosis of gestational diabetes?
OGTT
What happens in OGTT?
Patient is given a sugary drink and blood glucose is measured before, then at intervals after. Must fast for >8 hours before. Notable values are before the drink and 2 hours after
What are the values for diagnoses of gestational diabetes? (think 5678)
Fasting sample >5.6 + 2 hour sample >7.8
What are the values for diagnosis of diabetes (fasting, random glucose and HbA1c)
Fasting >7
Random >11
HbA1c >48
What are the HbA1c values for pre-diabetes?
42-47
Why is HbA1c generally preferred for diagnosis of DM2?
Why not for DM1?
Measures blood glucose control over past 3 months
Someone presenting with DM1 may not have had the condition for long enough
What type of sample is needed to diagnose DM2?
A venous sample
New diagnosis: what is the management for someone with a HbA1c of 48?
3-6 months of lifestyle advice
Or start monotherapy
When should you add a second drug?
If HbA1c >53
When should you add a third drug?
HbA1c >58
